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Patients with psychopathy need intensive care and supervision. There is however reluctance to treat them because of (supposedly) limted chances of success and risk of therapy-interfering behavior. This study focused on inpatient disruptive behavior in mentally disordered offenders during medium security treatment. Patients (N = 224) were assessed using the Psychopathy Checklist-Revised total, factor and facet scores and divided into three groups depending on the presence of low, medium, and high psychopathy traits. Associations between psychopathy and criminogenic risk and need factors were analyzed. Additionally, the association between psychopathy and therapy-interfering behavior (non-compliance, drop-out, institutional misconduct) was investigated with correlational and logistic regression analyses. The results showed that psychopathy was associated with greater risk, needs, and therapy-interfering behavior. PCL-R Factor 2 predicted institutional misconduct, whereas PCL-R Factor 1 predicted drop-out from treatment. The study highlights the importance of responsive treatment climates in retaining this difficult-to-treat group in treatment.

Structured risk assessment has become a part of routine practice in forensic settings. However, little attention has been paid to the clinical applicability of existing tools. The present research focused on the performance of the Historical Clinical Risk Management-20 (HCR-20) – one of the most commonly used tools for structured professional judgment – in the daily practice of three medium security units in Flanders. Areas under the curve for the prediction of violent recidivism during (N = 168) and after (N = 105) medium security treatment were non-significant. In addition, analyses showed that the HCR-20 was mainly of interest in identifying low-risk individuals. Further research measuring different aspects of predictive validity in applied settings is recommended.Keywords: Risk assessment, structured professional judgment, HCR-20, forensic psychiatry, field validity

AimTo examine the criminal outcome of Flemish forensic psychiatric patients (‘internees’) after medium security treatment. Also, the effect of conditional release on recidivism of two subgroups (internees under conditional release and internees who received unconditional release) was examined.MethodReconviction rates and revocation rates were collected for all participants. Kaplan–Meier survival analyses were used to investigate recidivism rates while controlling for time at risk.ResultsDuring the 10-year period, 502 offenders were discharged from medium security treatment. Over a follow-up period averaging 3.6 years, 7.4% of discharged patients were reconvicted or received a new ‘not guilty by reason of insanity’ (NGRI) verdict for a violent offence. One-quarter of the population had their conditional release revoked. Part of the study population was granted unconditional release. Reconviction rates were higher after unconditional release in comparison to conditional release.ConclusionsThe results of this study suggest that the court supervision of NGRI patients in Flanders is effective in protecting the community from further offending.KeywordsRecidivism, Conditional release, Forensic psychiatric patients, Mental health supervision, Medium security treatment

Background: A stable assessment of cognition is of paramount importance for forensic psychiatric patients (FPP). The purpose of this study was to compare repeated measures of IQ scores in FPPs with and without intellectual disability. Methods: Repeated measurements of IQ scores in FPPs (n = 176) were collected. Differences between tests were computed, and each IQ score was categorized. Additionally, t-tests and regression analyses were performed. Results: Differences of 10 points or more were found in 66% of the cases comparing WAIS-III with RAVEN scores. Fisher’s exact test revealed differences between two WAIS-III scores and the WAIS categories. The WAIS-III did not predict other IQs (WAIS or RAVEN) in participants with intellectual disability. Discussion: This study showed that stability or interchangeability of scores is lacking, especially in individuals with intellectual disability. Caution in interpreting IQ scores is therefore recommended, and the use of the unitary concept of IQ should be discouraged.

On 13 September 2005, the Court of Justice of the European Communities (hereafter: Court of Justice EC) passed a judgment giving rise to much controversy.1 In that judgment, the Court found that in some situations, the EC Treaty leaves room to take measures in a directive “which relate to the criminal law of the Member States” (para. 48). The authority to take criminal law measures in the First Pillar exists – concisely stated – if these measures relate to one of the essential objectives of the Community (cf. Articles 2 and 3 EC Treaty), and the use of effective, proportionate and dissuasive criminal penalties by the national authorities is an essential measure to achieve that objective.2 In view of the starting point that provisions of the EU Treaty may not prejudice those of the EC Treaty (Article 47 EU Treaty), actions of the Council within the Third Pillar – which concerns police and judicial cooperation in criminal matters as referred to in Article 29 ff. EU Treaty – may not encroach upon the competences of the Community in the First Pillar.3 This means that in cases